Is the Healthy Middle Ear a Normally Sterile Site?

Objective: To systematically evaluate the presumption that the healthy middle ear becomes colonized with organisms via the patent eustachian tube using modern microbiologic techniques. Study Design: Sterile saline washings were obtained from the middle ear of patients in a prospective fashion. Setting: Tertiary/quaternary referral centers. Patients: Pediatric and adult patients undergoing cochlear implantation surgery. Intervention(s): Standard bacterial and viral cultures, and nucleic acid amplification techniques. Main Outcome Measure(s): Identification of organisms. Results: Specimens were obtained from 13 children and 9 adults. No organisms were identified in any of the specimens, either through standard culture or PCR testing. Conclusion: The presumption that the healthy middle ear is colonized by bacteria from the nasopharynx is unsubstantiated.